The present population-based study proposes to continue the examination of time trends in the incidence, in-hospital, and long-term survival rates of acute myocardial infarction (AMI) and out-of hospital deaths due to coronary heart disease (CHD) in residents of the Worcester, MA, Standard Metropolitan Statistical Area (SMSA). The objectives of this observational study are to examine recent (2000 and 2003) as compared to prior (1975 to 1999) trends in the annual attack and survival rates of AMI, out-of-hospital deaths attributed to CHD, and the relationship of these incidence and survival patterns of AMI to demographic, clinical, and medical care factors. An additional objective of this multi-hospital community-wide study is to examine changes over time in the use of selected therapies and coronary interventional approaches in patients hospitalized with AMI. To accomplish these objectives, the proposed study will be carried out in the 12 acute care general hospitals in the Worcester, MA, SMSA (1990 census count = 437,000). This study will utilize and extend previous approaches used in the conduct of this longitudinal study. All new (incident) and recurrent episodes of definite AMI occurring among Worcester SMSA residents during calendar years 2000 and 2003 will be identified from discharge diagnostic printouts obtained from all metropolitan Worcester hospitals. The medical records of patients from the Worcester SMSA will be individually reviewed for validation purposes according to pre-established diagnostic criteria for AMI. Abstraction of the medical records of patients satisfying the diagnostic and geographic eligibility criteria will be carried out with the standardized recording of relevant data. A review of records for additional hospitalizations and a statewide and national search of death certificates will be carried out to examine the long-term survival status of discharged hospital patients from each of the proposed study years as well as those identified previously (1975 to 1999) through 2004. Death certificates will be reviewed to identify cases of out-of-hospital deaths due to CHD occurring in 2000 and 2003 to determine changes over time in these incidence rates. The results of this community-wide investigation will provide important insights from a 28 year vantage point about the magnitude of, mortality from, and treatment approaches used in the management of the nation's leading cause of death as it affects the population of a large and representative metropolitan area.